DEAR DR. DONOHUE: My hands shake, I presume, due to Parkinson's disease. I know nothing about it. How is it treated? -- F.C.
ANSWER: Not all shaking hands are due to Parkinson's disease. I had an uncle who said he had Parkinson's because his hands shook. After I became a doctor, I realized he never had Parkinson's. He had an entirely different problem -- essential tremor. That's my way of telling you not to self-diagnosis this matter.
Tremor is only one sign of Parkinson's. The kind of tremor is the kind that comes when the hands are at rest -- lying in the lap or on a table. Parkinson's patients move slowly. They take small steps and often shuffle. Their face freezes into an expressionless mask, and they blink infrequently. Their handwriting shrinks. Another characteristic sign is the tendency of Parkinson's patients to fall. They might also suddenly become unable to move, a phenomenon called freezing. Do you have any of these signs?
The basis of Parkinson's disease lies in a deficiency of a brain chemical, dopamine. Many Parkinson's medicines either restore brain dopamine levels or have an action that is similar to dopamine's.
Mirapex and Requip, two somewhat recent additions to Parkinson's treatment, imitate the action of dopamine and have an additional benefit of protecting brain nerves from progressive deterioration.
Sinemet is a medicine long used for this illness. It provides raw materials for boosting brain dopamine levels.
Electrodes implanted in the brain stimulate specific brain centers to shut down overactive brain cells that contribute to the motor problems of Parkinson's disease. This sounds like a drastic remedy, but it is quite similar to the pacemaker used to stimulate the heart.
I can give you only a small sample of Parkinson's disease treatments. Your task is to find a doctor who can confirm or deny your suspicions, something I wish I had had the knowledge to do for my uncle.
DEAR DR. DONOHUE: I have a meningioma and have had it for 10 years. I am 79. My doctor examines me every year, and I have a CT scan about every two years. The tumor is not growing, so he tells me nothing needs to be done. I don't feel comfortable with this thing growing in my brain, even though I don't have any symptoms. Should I get a second opinion? -- W.W.
ANSWER: A meningioma is a tumor of the meninges, the brain's covering tissues. Usually these tumors do not spread, so they are called benign. They can grow and compress brain tissue. The signs that result from such compression depend on what part of the brain is involved. Headache can arise from a large meningioma.
Because the majority are so slowly growing, a meningioma can usually be ignored. Your doctor is not giving you bad advice. Removing a small, symptomless meningioma can create more problems than it solves.
If you want a second opinion to allay anxiety, then no one would object to your getting one. I don't think you will get any different advice, however.
DEAR DR. DONOHUE: What is a pseudomonas infection? I have one, and the doctor tells me they are difficult to treat. How do you get this kind of infection? Is it sexually transmitted? -- F.F.
ANSWER: Pseudomonas (SUE-doe-MOAN-us) is the name of a bacterium. The germ is difficult to treat because it is left untouched by most antibiotics. Nevertheless, there are a few antibiotics that are active against it.
The site of infection both dictates the antibiotic chosen and predicts the difficulty of treatment. Pseudomonas infections can be in the ear, prostate gland, kidney, bladder, bone, skin, eye, blood -- you name it. Simply finding the germ doesn't prove infection. An elevated temperature, a discharge of pus and a high white blood count indicate the pseudomonas germ has invaded and is causing trouble.
Pseudomonas is not sexually transmitted. It's ubiquitous -- everywhere -- and contact with it is inescapable. Most of the time it does not cause infection.
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